IACUC Application Form
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APPLICATION FOR USE OF ANIMALS
NWOSU
This application must be completed in Microsoft Word and submitted in hardcopy
with original signatures. Ongoing projects must resubmit to the IACUC annually.
Any change of animal use protocol also requires resubmission. Please refer to
the resources on the IACUC web page when answering the questions below.
1. TITLE OF PROJECT:
2. PRINCIPAL INVESIGATOR(S):
I agree that the proposed research does not unnecessarily duplicate previously reported
research and appropriate consideration has been given to research design that does
not require the use of animals. In addition, all individuals working on this project are
appropriately trained for the species involved. Further, I am aware of the Animal
Welfare Act and Animal Welfare Regulations, the Public Health Service Policy on
Humane Care and Use of Laboratory Animals and the Guide for the Care and Use
of Laboratory Animals.
_________________________
Name
_________________________
Signature
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Name
_________________________
Signature
_________________________
Name
_________________________
Signature
_________________________
Department
_________________________
Campus
_________________________
Phone Number
_________________________
Date
3. TYPE OF APPLICATION (check one):
4. TYPE OF ANIMAL USE:
New Application
Renewal Year 2
Renewal Year 3
Protocol Change
Research
Testing
Teaching
Field Study
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5. OBJECTIVES OF THE STUDY OR CLASS:
Briefly explain, in non-technical terms, the purpose of the study and why it is
important.
6. ANIMAL IDENTIFICATION:
(a) Species:
(b) Numbers Used:
(c) Age:
(d) Weight:
(e) Sex:
(f) Stock or Strain:
(g) Source(s):
7. RATIONALE FOR INVOLVING AMINALS:
(a) Explain the rationale for using animals, in non-technical terms. Explain why
animals must be used and non-animal models cannot be used.
(b) Justify the appropriateness of the selected species.
(c) Justify the number of animals to be used.
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8. ANIMAL CARE:
(a) Animal Holding Location(s): Describe the appropriateness of the housing,
feeding and care for the selected species.
(b) Transportation: If animals are transported between facilities, or from the field,
describe the methods and containment to be utilized.
(c) Personnel: Describe the species-specific qualifications of all personnel caring
for the animals, including researchers and veterinarians.
9. ANIMAL USE:
(a) Animal Use Procedures: In non-technical terms, provide a clear and concise
sequential description of the proposed procedures involving the use of animals
(including surgical procedures, physical restraints, injections, blood withdrawals,
radiation, food and fluid regulation, use of non-pharmaceutical-grade chemicals
and other substances, etc.).
(b) Procedure Location(s): Describe the facilities where any procedures will be
conducted on the animals.
(c) Personnel: Describe the species-specific qualifications of all personnel
conducting procedures on the animals.
(d) Animal Well-Being: Describe the impact of the proposed procedures on the
animals’ well-being and how discomfort will be avoided or minimized.
(e) Pain and Invasiveness of Procedure: Describe sedation, analgesia, anesthesia
and surgical procedures to be used on the animals.
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(f) Post-Procedural Care: Describe post-treatment or postsurgical care and
observation of the animals.
(g) Anticipated or Selected Endpoints: Provide a description and rationale for the
anticipated or selected endpoint for the animals (i.e., euthanasia, long-term care,
etc.).
10. FIELD STUDIES:
(a) Describe the type of animal observations, interactions, disturbances and/or
special procedures anticipated in the field study.
(b) Describe how the study does not compromise the health and safety of either
the animals or the persons in the field.
(c) Provide copies of any required permits.
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11. IACUC REVIEWER SECTION:
Reviewer
Approved
Not Approved
Comments
12. APPROVAL:
IACUC Chair Signature ____________________
Date ____________________
IO Signature ____________________ Date ____________________